Insurance

General Information When you schedule your first appointment, the front office staff should find out what benefits are available to you. If a prescription or referral from your primary health care provider is required under your insurance plan, you will need to obtain it. In order to coordinate your care most effectively, we encourage patients to obtain required prescriptions or referrals before they come in for their first physical therapy evaluation.

After the examination, your physical therapist (with the guidance of your primary physician) will be able to predict the necessary treatment interventions and a general timetable of treatment. If it appears that the available insurance benefit will not cover the needed therapy, your therapist will recommend options that are available to you (for example, direct out-of-pocket payments or other arrangements). Your understanding of any benefit restrictions early in the therapy process will ensure fewer misunderstandings later and typically better outcomes.

Most of all, active participation in your physical therapy program will facilitate achieving optimal outcomes of care. Your therapist will give you homework (an at-home exercise program) that may include stretching or strengthening exercises as well as changes to make at your work station. If you are the caregiver for a family member, the therapist may instruct you in safety techniques and adaptations to make in the home environment. Your commitment and active participation in your program may shorten the overall length of therapy, and this will be helpful if the health care benefit is restrictive as to the number of visits available.

Note: Attention all United Healthcare, Pacificare, Definity Health, and SecureHorizons patients. As of December 1, 2008 we will no longer be contracted providers with these insurance plans. If you are currently receiving treatment and hold a policy with one of these companies, your benefit levels will likely change. Please call our office to discuss your options or if you have any questions regarding this change.

Accepted Insurance Plans

Aetna

CIGNA

Blue Cross/Blue Shield

First Choice Health Network

Premera

Regence

Uniform

Auto Insurance Companies

Labor & Industries

Helpful Insurance VocabularyProvider: One who delivers health care services within the scope of a professional license.Member: A term used to describe a person who is enrolled in an insurance plan; the term is used most frequently in managed care.Reimbursement: Refers to the payment by the patient (first-party) or insurer (third-party), to the health care provider, for services rendered.Policyholder: Purchaser of an insurance policy. This is usually the employer who purchases policy coverage for its employees.Co-insurance: In indemnity, the monetary amount to be paid by the patient, usually expressed as a percentage of charges.Co-payment: In managed care, the monetary amount to be paid by the patient, usually expressed in terms of dollars.Deductible: The portion of medical costs to be paid by the patient before insurance benefits begin, usually expressed in dollars.Denial: Refusal by insurer to reimburse services that have been rendered; can be for various reasons.Eligibility: The process of determining whether a patient qualifies for benefits, based on factors such as enrollment date, pre-existing conditions, valid referrals, etc.Gatekeeper: Refers to the provider designated as one who directs an individual patient?s care. In laymen?s terms, it is the one who refers patients to specialists (e.g. physical therapists) for care.Benefit Language: Defines who is eligible to receive care, how much care they can receive, and in what time period the care can be rendered. The language can either be very restrictive or all-inclusive.The above information has been provided as courtesy of APTA